Livingstone, who was making his debut in the format, jarred his knee while fielding a ball on the boundary on day two, after England had posted 657 in their first innings. He remained off the field for all of Pakistan's first innings, but did bat in England's second effort, scoring an unbeaten 7 but looking in clear discomfort as he hobbled between the wickets. He scored 9 in the first innings and did not bowl.

A scan on Sunday morning (day four) revealed the extent of the damage. He will now return to the UK on Tuesday and begin a rehabilitation programme under the supervision of the ECB and the Lancashire medical teams.

At this stage, England have yet to make a decision on whether to call up a replacement. A destructive batter in the shorter formats, Livingstone's main selling point on this tour was his spin capabilities, offering legspin and offspin options to the team. Will Jacks, drafted into the XI for this Test at the very last minute following illness to Ben Foakes, took 6 for 161 with offies of his own on debut. Meanwhile, Leicestershire's Rehan Ahmed offers an exciting albeit raw option as a legspinning allrounder.

Fast bowler Mark Wood, also with the squad, seems the most likely to replace Livingstone in the XI in the short term. The second Test at Multan, which begins on Friday, is expected to play out on a similar docile surface. The Durham quick's lightning pace will no doubt be a boost provided he can return to match sharpness in the next few days after missing the opening Test with a hip injury.